Request to Add or Revoke Directory Exemption Status

Request to Add or Revoke Directory Exemption Status
To ADD or REMOVE the Directory Exemption status from your student records please complete the following information. This form must be submitted with a copy of your valid photo id (must not be expired).
- Meet with your faculty advisor or Navigator if you are receiving federal or state financial aid, you are encouraged to speak with a financial aid specialist.
- Those receiving veteran's tuition assistance should speak with BMCC's certifying official.
- Changes are effective for the upcoming term.
Name

First NameLast Name
BMCC ID
Date of Birth

MonthDayYear
Date
Address

Current Mailing Address

Street Address Line 2

CityState

Zip Code
Phone Number
Format: (000) 000-0000.
Email Address
example@example.com
Choose one option
By completion and submission of this form I verify that
- I am the student that this request is being made for;
- The photo id provided is valid (not expired);
- This change will remain in effect until I chose to update this status at a later date;
- By removing this exemption status, Blue Mountain Community College, is permitted to share my directory information (ex: name, address, telephone number, date and place of birth, honors and awards, dates of attendance), in accordance with the Family Educational Rights and Privacy Act (FERPA)
- I have the option to place the directory exemption back on my student records at any time, however, by doing so understand that | will be unable to receive assistance over the phone or, if in person, without a valid picture id.
A note will be made in your student record regarding receipt of your request and supporting documentation. The copy of your documentation will be purged once your request has been processed.
Upload your Valid Phone ID. Example: Valid Drivers License

Cancelof
Student Signature Required
Date

MonthDayYear
Date
EEO Statement: Blue Mountain Community College is an equal opportunity educator and employer. See our complete EEO disclosure statement here.
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